Functional Status of Adults at Risk of Medicaid Disenrollment Under National Work Requirements

The One Big Beautiful Bill Act (H.R.1) implemented Medicaid work requirements for beneficiaries in states participating in the Affordable Care Act, but congressional policymakers are considering extending work requirements nationally to all Medicaid enrollees. However, little is known about Medicaid-enrolled adults at risk of disenrollment.

To assess the functional status and overall health of adults at risk of Medicaid disenrollment under national work requirements.

Cross-sectional study.

Medical Expenditure Panel Survey, 2022-2023.

Adults aged 19 to 64 years enrolled in Medicaid who did not meet common H.R.1 exemption criteria. Beneficiaries were classified as at risk of disenrollment if they worked less than 20 hours per week.

Measures of functional impairment across physical, neuropsychological, and independent living domains and composite measures of physical and mental health.

The annual weighted population of Medicaid beneficiaries aged 19 to 64 years was 16.5 million (mean age, 40.5 years; 54.4% female). Among these enrollees, 50.4% or 8.3 million (SE ±0.5 million) would be at risk of disenrollment by working too few hours. Compared with beneficiaries meeting work requirements, those at risk of disenrollment reported higher levels of functional impairment across physical, neuropsychological, and independent living domains. Proportions with poor self-reported health were also higher among beneficiaries at risk of disenrollment than those reporting better health (poor physical health: 32.7% vs. 10.9% and poor mental health: 28.2% vs. 19.5%, respectively).

Self-reported measures and inability to capture all exemption criteria.

Under national Medicaid work requirements considered by Congress, half of all beneficiaries would be at risk of disenrollment even though they had greater functional impairment and poorer health than those who were not at risk. These impairments might not meet formal disability criteria but could compromise enrollees' ability to adhere to work requirements, thereby increasing their risk of coverage loss.

Patrick and Catherine Weldon Donaghue Medical Research Foundation.